The FDA has indicated it will approve more and more injectable diabetes drugs to treat obesity. Most notably, the diabetes drug Ozempic given at a higher dose, is now also labeled as Wegovy to help patients lose weight. This trend has surged into the public eye as celebrities and everyday people alike tout their efficacy for quick weight loss. Many who can afford to do so are turning to medication to achieve their weight loss goals. Another diabetes drug, Mounjaro, was recently approved for obesity and labeled as Zepbound. As more diabetes medications are made available to treat obesity, many people are led to believe these drugs are an easy, turnkey solution for rapid weight loss. And while the results speak for themselves, the medications also raise questions about long-term health impact, equity, and what role lifestyle prevention programs will play.
Of the nearly 260 million adults in the United States, 37.3 million, or 14%, have been diagnosed with diabetes, whereas 96 million, or 40%, have prediabetes. The current trend in diabetes management is focused on treating diabetes once people are diagnosed, increasingly with medications like Ozempic and Mounjaro. Pharmaceutical companies are expanding their market presence to those who may have prediabetes by encouraging patients and providers to use their drugs for obesity treatment as well. To be sure, losing weight has demonstrated beneficial health effects such as preventing diabetes, lowering blood pressure, and reducing one’s risk for heart disease.
And while these drugs prove effective in achieving weight loss, there isn’t enough research to conclude that relying only on the drugs will allow patients to maintain the benefits in the long term. If patients regain the weight they lose while on the medication after they stop taking it, then the obesity-related health risks often return.
Furthermore, these medications work by decreasing patients’ appetite. When they do not eat a balanced diet, they run the risk of becoming malnourished, potentially worsening other health conditions that may coexist with obesity or diabetes.
As more patients are benefiting from these medications, healthcare providers must not forget to discuss comprehensive lifestyle changes as part of their diabetes and obesity treatment plans. In fact, both Wegovy and Zepbound, along with their diabetes treatment counterparts, highlight the need for a reduced-calorie meal plan and increased physical activity while taking the drugs. Incorporating these lifestyle changes along with stress management will help patients be much more successful while on the medications and when they stop taking them. These changes must be part of the overall weight loss conversation but are frequently ignored in the media.
Drug availability is also often overlooked by those seeking obesity treatment. Beyond shortages due to an increase in prescriptions, injectable diabetes and weight loss drugs are beyond reach for many who are without insurance or who are lower income and cannot afford the thousands of dollars in annual co pays.
Those who can afford the drugs have a distinct advantage over those who cannot, further exacerbating the socio-economic health disparities we see in society.
Medical professionals who prescribe these medications also determine who has access to these medications. Some physicians still believe obesity is a character flaw rather than a disease, and they refuse to prescribe weight loss medication to their patients whom they feel are not working hard enough to lose weight. Others are unjustly selective about who they prescribe the medications to. This is especially true for Black, brown, and low-income patients, for whom the literature on medical bias is clear – they are less likely to be prescribed weight loss medication. And yet, they are disproportionately impacted by obesity and related diseases.
That’s why it is paramount to allocate resources beyond medication and provide education on lifestyle change programs that have been proven to prevent diabetes and obesity-related conditions.
The CYL2 Lifestyle Change Program is one such example. It is CDC-recognized program that uses the participants’ lived experiences to inform behaviors that make the lifestyle change more approachable and easier to sustain in the long term. This program and other similar programs are successful in helping participants lose weight, whether they are using a weight loss drug or not. They have no barriers to entry and are accessible to everyone and should be part of the weight loss conversations taking place in all doctor’s offices.
If we forget to focus on diabetes prevention programs, the care gap will only widen, and Black, brown, and low-income patients will continue to be underserved. Widespread prevention programs focused on holistic lifestyle changes will level the playing field for everyone who is obese and at risk for diabetes, heart disease, or who currently has these conditions.
For all patients, the standard of care should be the same, regardless of their race or socioeconomic status. If and when more obesity medications are approved by the FDA and covered by all insurers, all patients should include lifestyle change programs in addition to whatever therapeutic they chose. Hopefully, injectable weight loss drugs will prove to be safe and effective; however, these drugs are only one piece of the weight loss puzzle. When patients stop taking the drugs, permanent weight loss is only achieved by holistic lifestyle changes. Wherever weight loss is discussed, whether in the doctor’s office or in the news, lifestyle change programs must always be a part of the conversation.
Linda Goler Blount
Linda Goler Blount is the president of the Black Women’s Health Imperative, the first and only national nonprofit solely dedicated to achieving health equity for Black women in America.
